Nasal septal abscess due to dental prosthesis

OtolaryngologyHead and Neck Surgery Volume 121 N u m b e r 2

procedure took 30 to 60 minutes with minimal bleeding and no ocular damage. Conclusion: Subperiosteal abscess occurs in approximately 10% to 15% of all acute sinusitis cases. The lreatment consists of intravenous antibiotics and drainage to prevent ocular and cranial injury. Endoscopic treatment of subperiosteal abscess has less morbidity and better cosmetic effect than the external approach.

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Lemierre's Syndrome: Necrobacillosls and Postanginal Sepsis STEPHEN P H CLYNE MS; WILLIAM F MCGUIRT JR MD; BRADFORD WARREN HOLLAND MD; Winston-Salem NC

Objectives: Lemierre's syndrome is characterized by thrombophlebitis of the internal jugular vein as a complication of anaerobic sepsis from an intraoral infection. Necrobacillosis is the term used to describe Lemierre's syndrome when caused by the bacillus Fusobacterium necrophorum. Rare cases of Lemierre's syndrome have been reported in the postantibiotic era, but blood cultures have seldom isolated this organism. Methods: We report a case of classic Lemierre's syndrome in a 15-year-old girl who developed necrobacillosis as a complication of pharyngitis. Blood cultures grew F necrophorum. The patient developed further complications from this disease, including pulmonary effusions and decreased mental status. Results: The patient was treated conservatively with intravenous antibiotics and without anticoagulation. Although critically ill, she was able to completely recover from this illness without suffering permanent morbidity. We review the clinical considerations and treatment options for this case and Lemierre's syndrome in general. Conclusion: Although quite rare, Lemierre's syndrome and necrobacillosis represent life-threatening complications of common clinical conditions seen by the general otolaryngologist. Familiarity with the pathophysiology and etiology of this disease will aid in its treatment. Advances in diagnostic imaging and interventional technologies bring new potential therapies for this old-time disease.

105 Unique Case of Simultaneous Laryngocele and Saccular

Cyst CARLTON J ZDANSKI MD; CHAPMAN T MCQUEEN MD; WILLIAM W SHOCKLEY MD; Chapel Hill NC; Burlington NC; Chapel Hill NC

Objectives: Laryngoceles and saccular cysts are rare benign cysts of the larynx that may lead to airway obstruction. Rare reports of bilateral laryngoceles may be found in the literature. We present the unique case of a simultaneous laryngocele and saccular cyst. Methods: The chart of a 45-year-old woman with the

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simultaneous presentation of a left laryngeal saccular cyst and a right internal and external laryngocele causing progressive airway obstruction was reviewed. The radiographs, pathology photomicrographs, and intraoperative photographs have been prepared for presentation. The current literature regarding etiology, pathophysiology, diagnosis, and treatment was reviewed. Results: A search of the literature revealed this to be the first reported case of simultaneous laryngocele and saccular cyst. After CT and microdirect laryngoscopy, the patient underwent transcervical excision of the saccular cyst and laryngocele with tracheotomy for airway protection. Conclusion: This is the first reported case of simultaneous laryngocele and saccular cyst. The management of the case is reviewed. In addition, the current literature regarding etiology, pathophysiology, diagnosis, and treatment is also reviewed and presented.

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Nasal Septal Abscess Due to Dental Prosthesis CIRIACO CRISTOVAO TAVARES ATHERINO MD; ROBERTO CAMPOS MEIRELLESPHD; LUCIANO AUGUSTO SOUZA MOREIRA MD; Rio de Janeiro Brazil; Rio de Janeiro Brazil; Juiz de Fora Brazil

Objectives: Nasal septal abscess (NSA) is not commonly seen and may be due to several factors including past surgery and trauma. In 1982, da Silva et al reported 2 cases of NSA with dental infection as origin. In the present study, 3 cases of NSA due to dental prosthesis are presented, and problems on diagnosis and surgical approaches are discussed. Methods: Clinical aspects, diagnosis, and treatment of 3 cases of NSA due to dental prosthesis seen in the last 8 years are presented. They had no history of past facial surgery or trauma, and other causes of NSA were excluded. All patients underwent surgical drainage by different techniques followed by culture. Results: In all 3 cases, anarnnesis, physical examination, and CT scan made a precise nasal septal abscess diagnosis. Etiology was assessed by exclusion after clinical history and blood studies. Posterior orthodontic examination reinforced the prosthesis origin. Conclusion: NSA is uncommon. Dental origin has been implicated only once. Dental prosthesis as origin was not seen in literature. It is important for the otorhinolaryngologist n o t only to recognize the NSA and proceed to a precise surgery technique but also to consider its possible etiologies, such as dental prosthesis.

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Unusual Presentations of Cat Scratch Disease ALEXANDER G CHIU MD; CHRISTOPHER P MESICK MD; DAVID A HECHT MD; SUZE~E K MIKULA MD; Bethesda MD; Falls Church VA; Arlington VA; Alexandria VA